Disclosures: Tam Quach, DO: No financial relationships or conflicts of interest

Case Description: The patient presented with left sided weakness, left sided involuntary flailing movements and difficulty ambulating for 2 weeks. MRI of the patient’s brain demonstrated high signals within the right lentiform nucleus. Patient’s blood glucose level was initially 254 mg/dL with a hemoglobin A1C of 14.6%. The patient was evaluated by neurology who assessed that his left sided hemichorea-hemiballismus was secondary to a right basal ganglia lesion as part of a non-ketotic hyperglycemia versus a possible paraneoplastic lung mass. On initial physical therapy evaluation, the patient ambulated fifteen feet with a rolling walker with moderate assistance of two. The patient’s blood glucose was controlled with glimepiride and an insulin sliding scale with blood glucose levels ranging from 75 to 326 mg/dL during his stay. Repeat MRI brain demonstrated a hyperintense T1 signal in the right putamen suggestive of NKH hemichorea as there was no focus of restricted diffusion to suggest acute infarct. Neurology was reconsulted while the patient was in acute rehabilitation and agreed with the diagnosis of NKH hemichorea.

Setting: Acute inpatient rehabilitation

Patient: A 64 year old male with a history of hypertension, type 2 diabetes mellitus and Parkinson’s Disease Assessment/

Results: The patient’s hemichorea progressively improved during his rehabilitation stay with strict glucose control and symptoms were minimal by time of discharge. Upon discharge, the patient was ambulating 85 feet with a rolling walker with minimal assistance.

Discussion: Hemichorea-hemiballism is a rare hyperkinetic disorder that can result in severe impairment for patients. Aggressive treatment has been found to completely improve the symptoms.

Conclusion: While it is a more rare complication, NKH hemichorea-hemiballismus can be an early manifestation of uncontrolled diabetes and should be considered as a differential for those presenting with chorea.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/nonketotic-hyperglycemic-hemichorea-hemiballismus-in-acute-inpatient-rehabilitation/